Harvard Mental Health Letter

Using lithium to reduce suicide risk in bipolar disorder

Why lithium is the best medication option, and how to make it work better.

As the treatment arsenal for bipolar (manic-depressive) disorder has expanded in recent years, some experts have become concerned that lithium — a mainstay of treatment since FDA approval in 1970 and still considered the most effective option for long-term therapy — may be falling out of favor.

Treatment options besides lithium include anticonvulsants with mood-altering properties, notably valproate (Depakene, Depakote), carbamazepine (Epitol, Tegretol), and lamotrigine (Lamictal), as well as antipsychotics and antidepressants. As the options have multiplied, prescribing patterns have shifted, not only for acute manic or depressed phases of bipolar illness, when agents that target specific symptoms may be required in addition to lithium, but also for long-term maintenance therapy intended to prevent recurrences of the illness and to minimize morbidity between episodes.

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